One study demonstrated that risedronate provides better fracture protection in the first year of treatment compared with alendronate (Osteo- poros Int 2007; 18: 25).

Strontium is a dual action bone agent that decreases bone loss as well as increasing bone formation. The spinal osteoporosis therapeutic intervention trial showed a 49 per cent reduction in the incidence of new vertebral fractures in the first year (NEJM 2004; 350: 459).

A study found that if a women had not fractured and had no risk factors, treatment for osteoporosis was effective from the age of 50 and cost-effective from the age of 60 (Bone 2005; 36: 22–32). This challenges NICE guidance.

Available guidelines

Royal College of Physicians’ document, Osteoporosis: Clinical Guidelines for the Prevention and Treatment.

In January 2005, NICE published guidance on the secondary prevention of fractures. Draft guidance on primary prevention has also been published.

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